Healthcare Provider Details

I. General information

NPI: 1083319537
Provider Name (Legal Business Name): ANDREA GRACE BOCOBO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BERRY ST STE 100
SAN FRANCISCO CA
94107-1758
US

IV. Provider business mailing address

751 S BASCOM AVE
SAN JOSE CA
95128-2699
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-4533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A25787
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: